<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005438
Report Date: 09/24/2020
Date Signed: 09/24/2020 03:07:08 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:OAKMONT OF ORANGEFACILITY NUMBER:
306005438
ADMINISTRATOR:CHARLES EUSEYFACILITY TYPE:
740
ADDRESS:630 THE CITY DR STELEPHONE:
(657) 221-5700
CITY:ORANGESTATE: CAZIP CODE:
92868
CAPACITY:155CENSUS: 103DATE:
09/24/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:47 PM
MET WITH:Administrator, Chuck EuseyTIME COMPLETED:
02:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Jenifer Tirre made a virtual unannounced tele-inspection visit via Zoom App due to COVID-19 Pre-cautions and measures. The purpose of the tele-inspection visit is to follow up on a Confirmation of Removal of a Exclusion Decision Order. LPA met with Administrator (AD) Chuck Eusey and stated the purpose of the visit and a virtual tour of the facility was conducted.

On 9/23/20, LPA received a copy of Exclusion Decision and Order on the removal regarding Staff 1 (S1), AD was asked to send over updated Facility Roster and was to remove S1 from the facility roster. AD was also asked for a copy of current staffing schedule to confirm removal. LPA toured Facility Common Areas, Living Room, Courtyard, Lobby, Bistro, Kitchen, Patio, Memory Care, Assisted Living, Salon, Exercise Room, and Dining room. LPA spoke to 9 staff Members and verified the individual was not present at the facility.

An exit interview was conducted via Zoom App.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1